Amherst docs perform prostate procedure with fewer side effects

A pair of doctors in the Northtowns have started to perform an procedure to ease problems caused by an enlarged prostate for men who don't tolerate medication well and are concerned about potentially more damaging options.

The UroLift prostate stents used in the procedure allow the urologists to peel open enlarged prostates without using heat or cutting devices – two options that can cause unwelcome side effects.

"This procedure preserves a lot of things the medications don't," said Dr. Michael Hanzly. "Sexual side effects, you don't have to worry about."

Hanzly and his colleague, Dr. John Griswold, have begun to perform the procedure in their practice, Buffalo Medical Group Urology Services in Amherst.

"No one knows precisely what causes an enlarged prostate but about 80 to 85 percent of men will develop one over the course of a lifetime," Griswold said. "It's extremely commonplace, a normal part of the aging process. Of that, approximately 30 percent of those men are going to run into troubles because of bothersome symptoms."

Imagine punching a straw through a walnut and emptying a vessel of liquid through the straw. Now imagine that, over time, the walnut has grown to the size of an orange and is pinching the straw to a point where it's hard to drain the vessel.

This is the kind of challenge roughly one in four older men face when it comes emptying their bladder as their prostate grows.

Urologists in recent years have used medication, microwave therapy and transurethral resection of the prostate (TURP) to reduce the size of an enlarged prostate and return a more predictable flow of urine from the bladder through the urethra.

Each of these methods comes with varying degrees of effectiveness, as well as side effects that can include sexual dysfunction, Griswold and Hanzly said.

The UroLift procedure can help with many benign enlarged prostate glands, the doctors said. Prostate cancer is treated differently.

"It will definitely catch on," Hanzly said. "It's such a good option."

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FOR MORE INFORMATION:

Call BMG Urology at 716-630-1050; officials at the practice say most health insurance covers the procedure

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"This is what an enlarged prostate can look like in your 50s to 80s," Dr. Michael Hanzly said of the image on the left, "and this is what it probably looked like in your 20s," he said of the image on the right. (Images provided by UroLift)

Here's what else the doctors had to say this week about the procedure:

Q. What are some of the more common symptoms of an enlarged prostate?

Griswold: Typically, men start waking up more at night to urinate. They have a lot more urgency and frequency of urination during the day. … Sometimes, it gets to the point where they don't empty their bladder well and they're retaining urine.

Q. What is the treatment protocol for an enlarged prostate?

Griswold: First of all, they need to have a good basic examination with a primary care physician. The first line of therapy is always medication. There's two types of medication: medication to decrease the prostate in size and medication to relax the prostate and allow you to urinate better. We frequently give patients either/or, or both of those medications at the same time, as symptoms warrant.

But these medications have side effects. Many men cannot tolerate them at all. That's one of the groups this kind of procedure is ideally suited for. Sexual side effects are the most prominent. That bothers guys a lot. There also can be dizziness … to the point to where you almost pass out because you're so lightheaded.

Q. Who makes a good candidate for the prostatic stent procedure?

Griswold: Generally speaking, following a standard algorithm of care, a patient comes in and should be examined and evaluated. We want to make sure nothing else is going on, that there are no signs of cancer. Then they should try medication first. The most common reason we do this procedure is the medication doesn't work or they can't tolerate the side effects. There is going to be a subset of patients who are going to want to get it done because they don't want to take medication for the rest of their life. "Why am I going to take this medication when I'm 54 and take it till I'm 84, when I can go off medication?"

Q. If medications don't work well, what are the other options?

Griswold: Traditionally, the next level is minimally invasive therapies like this kind of procedure. Microwave therapy has been used for many years. It works very well for a select group of patients but has been somewhat disappointing for others. We were in need of a better alternative.

Q. What are some of the potential complications with microwave therapy?

Griswold: The problem is that microwave therapy works by heating the prostate and it takes several months to be effective. You don't get immediate improvement and it can make things worse while you're improving. A significant percentage of the time, it doesn't really help. … The next option is this procedure, the UroLift. The main option is the TURP, the transurethral resection of the prostate. That's something that most men want to avoid but it's still necessary for many, many men.

Q. Why?

Griswold: It's more invasive. We go in with a scope and physically remove and cauterize tissue. It involved general anesthesia, hospitalization, much more significant risk of bleeding, infection, scarring, incontinence. There's more risk for sexual side effects, too. But it should be emphasized it's still a very good procedure and many men need this procedure done. In the next several weeks, I have several of these scheduled. There are certain types of conditions that are better managed with TURP.

Q. So you would try this prostate stent procedure first?

Griswold: In many cases. There are some limitations to the procedure. The volume, the size of the prostate, is one of them. If it's too large, we can't do this procedure. There's also a certain shape to the prostate. If there's a large middle lobe, this indicates you shouldn't do the procedure.

But the advantage of it is it's an outpatient procedure done in the office. Patients come in and the whole experience takes approximately an hour. There are times when they need to have a catheter afterward but the majority of patients don't. And because the procedure opens up the prostate, you have immediate improvement. Because you're not removing any tissue, there are really no major sexual side effects. They may have a little bit of burning or urgency or frequency for the first week or two, but it generally resolves and becomes much improved.

Q. What about success rates?

Griswold: In clinical studies, it's in the range of 90 percent, which for this type of thing is really good. Microwave, the numbers are anywhere from 50 to 70 percent improvement.

Q. Can you describe this outpatient surgery? What is it like and what are the stents like?

Hanzly: We go in with a cystoscope, which is a device to look into the prostate. It goes in through the urethra. You're obviously asleep and comfortable for this part. After we've gone into the bladder and makes sure it looks fine and healthy, we come back and slide into the prostate with the scope and insert the UroLift single-use device. It slides into the cystoscope and deploys a Urolift itself.

Each stent is essentially a stainless steel clip, a suture and another clip. We typically use between four or six (to pull apart the prostate). It's usually two per side. If the prostate is a little longer, we put in three, or up to four a side. It's a judgment call when you're in the prostate.

Q. Who should get a PSA test and how often?

Griswold: That's an extremely long discussion because there's a lot of different schools of thought. The current guidelines say that men between the ages of 50 and 75 should have PSAs done annually or maybe every couple of years, but only after they have a really good, long discussion with their primary care physician about the risk and benefits of testing PSA. It's important they have a really good understanding about what PSA testing means and the pitfalls and advantages.

When you're talking about PSA testing, the controversy is for screening for men who are having no symptoms, no problems, and are just coming in to see the doctor. Every man who has symptoms or problems with their prostate needs to have a PSA test.